Understanding Childhood Trauma: Types, Effects, and Responses

School

SUNY Empire State College**We aren't endorsed by this school

Course

CHFS 3020

Subject

Psychology

Date

Dec 11, 2024

Pages

Uploaded by ProfGuanacoPerson655

M1 content Guide: overview of child traumaAn IntroductionChildhood trauma is a broad and complex topic. In this first module, we will take an overview of how child trauma is defined and what distinguishes it from other painful things that can happen in a child’s life.We will look at the types of childhood traumatic events, such as child abuse and neglect, car accidents, natural disaster, and invasive medical procedures.We will look at the factors that affect a child’s experience of a traumatic event – either to protect the child from long-lasting effects, or to increase therisk of long-last effects of the traumatic event.We will take our first look at the range of physical and emotional and behavioral responses children often have to traumatic events – both short term reactions, and the longer-term reactions such as Post Traumatic Stress Syndrome (PTSD) and Child Traumatic Stress.And lastly, we will look at how often traumatic events happen for children in the U.S. and of those children, how many develop long-term negative effects.I. Four important definitionsFirst off, let’s start with four important definitions.A. “Trauma”:The DSM-5 definition of trauma requires “actual or threatened death, seriousinjury, or sexual violence” (American Psychiatric Association, 2013).Stressful events not involving an immediate threat to life or physical injury such as psychosocial stressors (e.g., divorce or job loss) are not considered trauma in this definition(Pai, Suris, & North, 2017).We distinguish trauma from other kinds of bad things that happen to people because in trauma it is the credible threat of loss of life or physical well-being that sets off the unique physiological reactions in trauma. While the

divorce of a child’s parents or death of a relative may be ultimately more painful and impactful on a child’s life than the trauma of a car accident or an assault, it is the latter that qualifies as a “trauma” because they are threats to the physical well-being of the child.B. “Traumatic event”:A traumatic event is a frightening, dangerous, or violent event that poses a threat to a child’s life or bodily integrity. Witnessing a traumatic event that threatens life or physical security of a loved one can also be traumatic. This is particularly important for young children as their sense of safety depends on the perceived safety of their attachment figures.Traumatic experiences can initiate strong emotions and physical reactions that can persist long after the event. Children may feel terror, helplessness, or fear, as well as physiological reactions such as heart pounding, vomiting, or loss of bowel or bladder control. Children who experience an inability to protect themselves or who lacked protection from others to avoid the consequences of the traumatic experience may also feel overwhelmed by the intensity of physical and emotional responses(NCTSN, 2012).C. “Traumatic exposure”:A traumatic exposure is a confrontation with actual or threatened death, serious injury or other threat to physical integrity(APA, DSM-5, 2013).D. “Reactions to trauma”:The focus of much of our work as counselors and parents is how a child reacts to a traumatic event. There are short-term physiological reactions such as neurological and physiological changes, and emotional reactions such as fear, shock, and anger. Some of these initial reactions resolve fairly quickly, but other reactions make a longer term impact on the child’s brain and behavior, such as child traumatic stress or PTSD.II. Types and characteristics of traumatic events:A. There are many types of potentially traumatic events:Abuse (physical, sexual, or emotional)NeglectEffects of poverty (such as homelessness or not having enough to eat)Being separated from loved ones

BullyingWitnessing harm to a loved one or pet (e.g., domestic or community violence)Natural disasters or accidentsUnpredictable parental behavior due to addiction or mental illnessFor many children, being in the child welfare system becomes another traumatic event. This is true of the child’s first separation from his or her home and family, as well as any additional placements (Child Welfare Information Gateway, n.d.).B. Traumatic events vary from each other in a number of ways, and some traumatic events may be much more harmful than others, of course. These characteristics of a traumatic event affect how impactful the event may be:The severity of the event: How badly was the child or other person hurt? Wassomeone hospitalized? Were the police involved? Were children separated from caregivers? Did a friend or family member die?The child’s proximity to the event: Was the child present during the event or did they hear about it, see it on TV, etc. Did it happen to themselves or close one, or another person?The frequency of the event: How often it happened, how predictable was the eventThe degree to which the event impacted the child’s entire life, called the “immersiveness” of the event.Whether the event was caused by a person (especially a close person) versus a natural disaster (NCTSN, n.d.).III. Other factors that impact a child’s experience of traumaIn addition to “trauma factors” such as severity and proximity, noted previously, “child factors” and “community factors” impact the child’s experience of trauma.A. Child factorsAge: Young children with rudimentary cognitive/language and coping skills have a harder time handling traumatic events – without a lot of support – than more mature children.Individual resources, such as intelligence, physical health, self-esteem can protect and child from the adverse effects and help them cope with a traumatic event. (Protective factor)

Prior history of mental health issues can make a child more vulnerable. (Risk factor)Past trauma can make a child more vulnerable and/or more resilient to a current traumatic event. If the child has worked through a prior trauma, she/he may have learned coping skills. (Protective factor) On the other hand,if a prior trauma is still an open wound, the child may have a harder time managing a new trauma exposure. (Risk factor)Traits of temperament such as sensitivity and rigidity, or stamina and heartiness may shape how a child reacts to trauma. (Protective or Risk factors)***The child’s perception of the danger in the event and the amount of fear the child felt at the time are significant risk factors for harm from the event.B. Family and community factorsCritical to a child’s reaction to a traumatic event are the responses of caregivers to the traumatic event and/or to the child’s reactions to the event.If the child’s family is blaming, distrusts the child, or avoids the reality of the trauma exposure, the child is at more risk for on-going harm. Whereas if the family supports and accepts the child’s reactions and the reality of the exposure, the child has stronger protection against sustained harm.Responsive, helpful relationships with family and caregivers (protective factors).Supportive school and community environment (protective factors).Financial supports for the family, and/or child mental health resources in the community (protective factors).Lack of community supports in situations of poverty, forced migration, wartime. (Risk factors) (NCTSN, n.d.; NCTSI, n.d.).C. The current thinking is that PTSD (or long-term harm) is caused by multiple factors, systemic interactions among them, and a process of such interactions among factors that unfolds over time. There is no single or linearcausation of PTSD that you can point to. For example, a child may have initial family support after a house fire, but over time, the parents may become depressed and isolated and the support will turn to avoidance. Or

the converse, a child may feel completely isolated about a frightening bullying situation, but a parent or teacher can uncover the abuse and begin to protect and support the child (Alisic et al, 2011; Pat-Horenczyk et al, 2009).IV. Overview of children’s reactions to traumatic events:(We will look more closely at the child’s reactions to traumatic events in Modules 4 & 5)Immediate reactions: shock, overwhelm, dissociation, terror (Levine & Kline, 2006, p. 97-101)Short-term reactions: temporary and not severe versions of symptoms belowLonger-term reactions:1.In the current DSM-5, PTSD applies to children over the age of 6 and adults:oCriteria one: exposure to a traumatic eventoCriteria two: intrusive symptomsoCriteria three: avoidance of stimuli related to exposureoCriteria four: negative thoughts or feelingsoCriteria five: hyper-arousal and reactivity(APA, 2013 cited in SAMHSA, 2014)2.In the current DSM-5, children under 6 did get a separate subtype of PTSD in the DSM-5: the section is titled “Posttraumatic Stress Disorder for Children 6 Years and Younger”. It lists the same set of symptom criteria as the PTSD diagnosis above, but the symptoms are described behaviorally rather than psychologically, and there are fewer symptoms in each criteria. This is because very young children don’t have the introspection or language to express their distress in language as older children and adults do.3.In the current DSM-5, Acute Stress Disorders list the same criteria as the PTSD criteria above, but fewer criteria are required to meet the diagnosis.4.Child Traumatic Stress is defined this way:“…intense and ongoing emotional upset,depressive symptoms and anxiety,behavioral changes,difficulties with self-regulation,problems relating to others and forming attachments,

regression and loss of previously acquired skills,attention and academic difficulties,nightmares,difficulty sleeping and eating,and physical symptoms such as aches and pains”(National Child Traumatic Stress Network, n.d.).V. Incidence/prevalence:Child trauma occurs more than you think:More than TWO-THIRDS OF CHILDREN reported at least 1 traumatic event by age 16.The national average of child abuse and neglect victims in 2013 was 679,000, or 9.1 victims per 1,000 children.Each year, the number of youth requiring hospital treatment for physical assault-related injuries would fill EVERY SEAT IN 9 STADIUMS.More than half of U.S. families have been affected by some type of disaster (54%, NCTSI, n.d.).Not every child who is exposed to a traumatic event will develop long-term serious reactions, such as PTSD, in fact approximately one in three will. Estimates vary, but a ballpark number derived from a review of many studiesis that 2 of 3 kids exposed DO NOT develop PTSD (Fletcher, 2003).Not all outcomes of trauma exposure are negative. As with adults, children may experience posttraumatic growth: closer to their families, stronger, spiritual awareness, appreciation of life, and new possibilities (Laceulle et al, 2015). Most children can get through a painful time, but then it is done and they are often stronger for it.The severity of the child’s reactions to a traumatic event are shaped by the characteristics of the traumatic event itself, and the characteristics that the child brings to the situation, and the characteristics of the child’s family and community environment. (See above)

M2 content guide: the neurobiology of stress and traumaIntroductionStudents often ask: If a young child experiences stress or trauma and they don’t remember what happened, how can it have an impact on them? For example, if a child isn’t given the care and attention she needs in infancy butlater, as a toddler or school-age child, has all of her basic needs met and receives lots of love, what difference can the early neglect have on her life? The answer lies in understanding how experiences effect our bodies and brains even when we don’t make conscious memories of those experiences.The Human Stress ResponseLet’s look at how humans have evolved to cope with stress. The stress response is a complex interaction of brain and body activity. Early humans needed to respond quickly to threats in their environments, such as dangerous animals or other humans who might steal their food (and sometimes modern people experience life-or-death threats, too, of course.) The fight, flight, or freezeresponse is an automatic activation, which originates in the brain, that tenses muscles, makes the heart pound, slows digestion, produces sweat to cool the body, along with other physiological changes. These changes prepared early humans to run away from danger or prepare, fight it off, or staying completely still to ensure their survival.While we are far less likely to face the threat of an angry lion today, our brains and bodies still respond in much the same way as our ancestors’ did thousands of years ago. When you are late for an important meeting or are worried about paying your bills, your brain may perceive a threat and jump into action, producing the fight, flight, or freeze response. You may notice that you have trouble thinking clearly at times like these; that is also part of the stress response, as our autonomic nervous system (responsible for automatic functions like breathing and heart rate) takes over our neocortex (the rational thinking part of the brain.) We sometimes call this panic. The threat is not life-or-death, but in your brain and body, it may certainly feel like it is.More recently, a fourth response has been added; fawn. This response entails the individuals acts of pleasing someone in order to avoid conflict. Overall, the end goal of all four stress responses is to evade or decrease

chances of danger and enable to individual to return to a more relaxed or calm state.Stress, Trauma, and the Brain-Body ConnectionThe amygdala is a part of the brain that processes emotions and sends messages to other parts of the brain. The hypothalamus is another part of the brain that acts as a kind of “command center” by sending signals to the body’s nervous system. The autonomic nervous system, mentioned above, has two parts: the sympathetic nervous system, which activates nerve cells calls the heart muscle, skeletal muscles, and glands into action, and the parasympathetic nervous system, which triggers the body’s systems to relaxand calm down.When the nerves in the body senses a threat, signals are sent through the spinal cord and cranial nerves into the hypothalamus.; The amygdala (emotion center) also signals the hypothalamus to the threat. The sympathetic nervous system acts when the hypothalamus tells the adrenal glands to produce a chemical called epinephrine (also known as adrenaline). Epinephrine triggers the sweating, rapid heartbeat, and accelerated breathing that we know as the fight, flight, or freeze response.As the initial surge of epinephrine subsides, the hypothalamus activates the next part of the stress response, which is called the HPA axis. This consists ofthe hypothalamus, the pituitary gland, and the adrenal glands. If the threat persists (or if the brain and body perceive that it does), the hypothalamus sets in motion a series of actions that leads the pituitary gland to release a hormone called cortisol, which keeps the stress response going.Once the perceived threat is gone, the parasympathetic nervous system communicates with the same organs that revved up the stress response but now tells them to deactivate and calm the body.;The Triune BrainIn chapter 4 of Levine & Klein, you will learn about what is known as the Triune Brain. This concept was first developed by Dr. Paul D. MacLean in the 1960s to explain how the brain developed throughout evolution.; When a person experiences a perceived threat, the reptilian brain perceives sensations, or physical feelings, associated with fear. The reptilian brain may

shut down all non-essential bodily functions and trigger the fight, flight, or freeze response. The mammalian part of the brain includes the amygdala and the hippocampus and governs emotional reactions and memories. Trauma can impact how the brain stores memories of events, which contributes to traumatic reactions that we will discuss in future modules of this course. Finally, the neocortex or the primate/human brain is responsible for our higher mental functions and enables us to make rational decisions when faced with a threat.; Traumatic situations can cause the "lower" brain regions to hijack the neocortex, preventing us from thinking clearly. As described above, when the parasympathetic nervous system is able to do its job, the brain and body can go back to functioning normally after a trauma, enabling people to mentally and physically process what has occurred.Children’s Brain Development and the Stress ResponseNow, let's learn about how the brain develops as it interacts with experiences from the environment by reading this short article: Early Experiences Shape the BrainIt is widely accepted that long-term or repeated stress and trauma can impact how a child’s brain develops, which can have negative physical, mental health, and cognitive effects over the life course.; Adverse childhood experiences include frightening and threatening events, abuse, extreme disruption or lack of predictability in daily life, and the absence of care and stimulation in infancy. These effects of these experiences are especially harmful when the stresses or trauma occur in “high doses” (high frequency and intensity of the traumas) and/or when they happen very early in a child’slife, as much brain development takes place during the first few years of life.There are several neurobiological mechanisms through which the developingbrain may be impacted by stress and trauma. One is the way that excess cortisol caused by an overactivation of the HPA system can disrupt how a child responds to stress after traumatic events. Some children’s cortisol production remains chronically high after long-term stress, resulting in ongoing fear and anxiety—a constant state of fight, flight, or freeze—even when the child is in a relatively safe situation. Another, more surprising, effect is called cortisol blunting. This condition happens when chronic HPA system activation leads the body to adapt to high cortisol levels. Cortisol remains low in the child’s bloodstream because their stress response system has become used to high stress and, therefore, does not kick in even in the

presence of new threats. Children with cortisol blunting are likely to show signs of apathy and depression.As you learned in the videos on brain development, the human brain changes, learns, and grows with new experiences—what is called brain plasticity. Young children’s brains undergo certain sensitive periods during which they are more likely to learn new things but are also more vulnerable to disruptions to the normal developmental processes. When excessive stress and trauma occur during sensitive periods, the amygdala, hippocampus, and prefrontal cortex may not grow as they should. Without the opportunity to make neural connections at the appropriate times, children’s brains may not develop properly with regard to memory, emotion-regulation, impulse control, and flexible thinking. Without proper interventions, deficits in these areas can lead to serious academic problems, aggressive behavior, disrupted relationships, and mental health problems such as dissociation (feelings of unreality or disconnection from the body) and depression.Prevention and Intervention for the Neurobiological Impacts of TraumaOf course, the best way to prevent the types of brain development disruptionthat we have been discussing is the protection of children from trauma. Parenting education programs that focus on attachment and responsiveness to children’s needs can help prevent child neglect and encourage caregivers to shield their children from traumatic events like family and community violence. Child welfare interventions that promote and enhance child safety and poverty reduction programs aimed at reducing chronic stress in families can go a long way toward protecting young brains from disrupted development.M3 Content Guide – Immediate Assessment After a Trauma

Immediate Responses to a TraumaAs we have learned, a child's brain and body will respond to frightening events and traumas. Remember that the brain's amygdala triggers the release of the stress hormones cortisol and adrenaline. These increase the body's heart rate, blood pressure, and breathing, to prepare for fight or flight(van der Kolk, 2014). When this happens in a child, you are likely to observe physical and behavioral changes that let you know that the child's brain and body are working to respond to the trauma.In the event that a child experiences something very frightening or disturbing, check the child for the following:Eyes and mouth: wide open, in an expression of startleEyes: glazed or dilated pupilsBreathing: rapid or shallowPulse: rapid or unusually slowDoes the child seem dazed and confused?Is she/he talking as if she were somewhere else?Does he/she have a vacant look on his face?Is she overly emotional, screaming, or crying?Is she overly tranquil, as if nothing has happened?(Levine & Kline, 2007, 2019, p. 98)If you observe any of these signs of the trauma response, engage the child ina calm and supportive way. See Content Guide 2 on Psychological First Aid for specific strategies.M3 Content Guide – First Aid for Psychological TraumaTrauma First AidChapters 4-8 of Levine & Klein provide guidance for parents and other adults on ways to respond to a child’s immediate reactions to everyday frightening events and more serious traumas. Quick and sensitive interventions by adults who are aware of the potential impacts of trauma can help reduce the long-term negative impacts on children.The National Child Traumatic Stress Network describes Psychological First Aid as, an “approach to help children, adolescents, adults, and families in theimmediate aftermath of disaster and terrorism” (NCTSN, n.d.). The eight “core actions” of Psychological First Aid are:

5.Contact and Engagement: To respond to contacts initiated by survivors, or to initiate contacts in a non-intrusive, compassionate, and helpful manner.6.Safety and Comfort: To enhance immediate and ongoing safety, and provide physical and emotional comfort.7.Stabilization (if needed): To calm and orient emotionally overwhelmed or disoriented survivors.8.Information Gathering on Current Needs and Concerns: To identify immediate needs and concerns, gather additional information, and tailor Psychological First Aid interventions.9.Practical Assistance: To offer practical help to survivors in addressing immediate needs and concerns.10.Connection with Social Supports: To help establish brief or ongoing contacts with primary support persons and other sources of support, including family members, friends, and community helping resources.11.Information on Coping: To provide information about stress reactions and coping to reduce distress and promote adaptive functioning.12.Linkage with Collaborative Services: To link survivors with available services needed at the time or in the future.M4 Content Guide - Long-term Reactions: What domains does a comprehensive trauma assessment cover?While the majority of children will have an initial reaction to a trauma exposure, only about one-third of the children will develop long term reactions to the traumatic exposure, according to a review of trauma exposure outcome studies done by Fletcher (2003). This fact surprises many people because the “common knowledge” is that trauma exposure can harma child for life. It is important for counselors and parents to know that traumaexposure is not a “life sentence” for most children. Children are resilient, andwe will discover in Module 6 on Interventions, there is much that parents andcounselors can do to help even the most injured children restore their well-being and heal.In this fourth module, we will first study how counselors assess whether a traumatic exposure has happened because it’s not always clear if a child hassuffered some kind of traumatic event, and children can’t or won’t always telltheir parents. Once it has been established that a possible trauma exposure happened, we will see how counselors assess the child’s reactions to it. These are two main components of a trauma assessment, #1 and #2 of the domains of a comprehensive assessment,

Finally, we will look in more depth at the longest term reactions to childhood trauma: long term Child Traumatic Stress and the long term effects of Adverse Childhood Experiences (ACEs) on the negative side, and Post-traumatic Growth (PTG) on the positive side of things.I. What domains does a comprehensive trauma assessment cover?Kisiel and her colleagues (2010) spell out the parts of a child’s life that should be studied when doing a comprehensive trauma assessment:1.Exposure to potentially traumatic/Adverse Childhood Experiences2.Symptoms related to traumatic/Adverse Childhood Experiences3.Child Strengths4.Life domains5. Acculturation6.Child behavioral/emotional needs7.Child risk behaviors8.Caregiver needs and strengths (Kisiel, Lyons, Blaustein et al, 2010).Please look at Kisiel et al (2010) Child and adolescent needs and strengths (CANS) manual: The NCTSN CANS Comprehensive – Trauma Version: A comprehensive information integration tool for children and adolescents exposed to traumatic events.M4 Content Guide - Long-term Reactions: How do you determine if a trauma exposure occurred and how severe it was?III. How do you determine if a trauma exposure occurred and how severe it was?Child and adolescent needs and strengths (CANS) manual: The NCTSN CANS Comprehensive – Trauma Version: A comprehensive information integration tool for children and adolescents exposed to traumatic events and study the rubric counselors use to make at least an initial assessment whether a traumatic level exposure has occurred.Specifically, study the rubrics for:1. Sexual Abuse2. Physical Abuse5. Medical Trauma, and11. Terrorism affected.

This last rubric describes the degree to which a child has been affected by terrorism. Terrorism is defined as "the calculated use of violence or the threat of violence to inculcate fear, intended to coerce or to intimidate governments or societies [or social groups] in the pursuit of goals that are generally political, religious, or ideological." Note: incidents of hate crimes against gay or trans individuals, or racialized violence, such as the violence against unarmed black children and adults in the US by police officers, are examples of this rubric. Ask yourself how useful these very rough rubrics are? What are the benefits of consulting them, do you think? What do they miss?M4 Content Guide - Long-term Reactions: How do you identify and assess various trauma reactions at different ages?III. How do you identify and assess various trauma reactions at different ages?Levine & Kline (2007, 2019) keep it simple: “The heightened arousal energy together with shutting down (when there is no escape) are biologically hard-wired survival mechanisms. However, this protective system is meant to be time-limited; our bodies were designed to return to a normal rhythm soon after the danger ends" (p. 41).A. These are most common trauma reactions that a wide survey of counselors said were reported by parents and children and assessed:1.Avoidance of trauma-related thoughts or feelings [DSM-5 criteria]2.Intrusive memories of the event or nightmares about the event [DSM-5 criteria]3.Hyper-arousal or exaggerated startle response [DSM-5 criteria]4.Irritable or aggressive behavior5.Behavioral problems6.Interpersonal problems7.Other problems based on the developmental needs and age of the child (NCTSN, n.d.)Note:As you see some of the trauma reactions most commonly reported match the criteria for PTSD set by the DSM-5 and some do not.

Note:With very, very young children, it is difficult to screen specifically for “trauma symptoms.” Rather, a provider may screen for exposure to traumatic events and social and emotional difficulties, such as attachment difficulties or mood dysregulation. (NCTSN, n.d.)Let’s go into more detail on these reactions. This list is drawn from Levine & Kline (2006/2007) and NCTSN (n.d.) and Child Welfare Info Gateway (n.d.) as noted.1. Avoidance of trauma-related thoughts or feelingsInfants and toddlers: a child avoids the pet dog after a fall when the dog barked.School-age children: a child avoids after-school activities where bullying happened, or family gatherings in general where an uncle had molested him/her.Adolescents: a teenager avoids excited feelings, sexual feelings, engaging in social activities after an attempted date rape.2. Intrusive memories of the event or nightmares about the event [DSM-5 criteria]All ages may experience:Unwanted upsetting memoriesNightmaresFlashbacksEmotional distress after exposure to traumatic remindersPhysical reactivity after exposure to traumatic reminders(National Center for PTSD, n.d.; NCTSN, n.d.)3. Hyper-arousal or exaggerated startle response [DSM-5 criteria]All ages may experience:Irritability or aggressionRisky or destructive behaviorHypervigilanceHeightened startle reactionDifficulty concentratingDifficulty sleeping4. Irritable or aggressive behaviorInfants and toddlers:

fighting a lot,oppositional behaviorSchool-age Children and Adolescents:Overly negative thoughts and assumptions about oneself or the worldExaggerated blame of self or others for causing the traumaNegative affectDecreased interest in activitiesFeeling isolatedDifficulty experiencing positive affect5. Behavioral problems:Infants and toddlers:fear of being separated from their parent/caregivercry and scream a loteat poorly or lose weighthave nightmares (SAMHSA, n.d.)frequent tantrumsclinginess, reluctance to explore the worldrepeating traumatic events over and over in dramatic play or conversationdelays in reaching physical, language or other milestones (Child Welfare Info Gateway, n.d.)School-age children:become anxious or fearfulfeel guilt or shamehave a hard time concentratinghave difficulty sleeping (SAMHSA, n.d.)being quiet or withdrawn, frequent tears or sadnesstalking often about scary feelings and ideasdifficulty transitioning from one activity to the nextchanges in school performanceeating much more or less than peersfrequent headaches or stomach aches with no apparent causebehaviors common to younger children (thumbsucking, bed-wetting, fear of the dark) (Child Welfare Info Gateway, n.d.)Adolescents:develop eating disorders or self-harming behaviorsbegin abusing alcohol or drugs

become involved in risky sexual behavior (SAMHSA, n.d.)talking about the trauma constantly, or denying that it happenedrefusing to follow rules, talking back constantlyrisky behaviors, running away from home, or getting into trouble with the law. (Child Welfare Info Gateway, n.d.)6. Interpersonal problemsAll ages may experience difficulties with trust, feeling safe, anger and betrayal.Infants and toddlers:clinginess (Child Welfare Info Gateway, n.d.)School-age children:fighting with peers and adultswanting to be left alonegetting into trouble in school or at home (Child Welfare Info Gateway, n.d.).Adolescents:fightingnot wanting to spend time with friends (Child Welfare Info Gateway, n.d.).M4 Content Guide - Long-term Reactions: Post Traumatic GrowthC. And then there is Post Traumatic Growth (PTG)Most of the attention of researchers, health care providers, and parents is focused on the long term negative impacts of trauma and how to heal them. Naturally. However, there is growing research interest in the long term growth that can derive from trauma – often alongside the negative impacts! The formal term for this research is Post-Traumatic Growth (PTG).Findings:“Growth following adversity have been reported to occur in five domains of an individual’s life including; life appreciation, improving relationships, identifying new possibilities in life, a sense of spiritual awakening and personal strength.After experiencing a traumatic event, survivors start to give more attention to those small things that were once considered less significant. Identify new

opportunities that did not exist before and perceive emotional connectedness. They perceive more strength to deal with future challenges of life, and have the subjective perception of better understanding regarding spiritual matters.”(Aslam & Kamal, 2019).Just as there is an ACE Index that you can take, there is a post-traumatic stress index that you can take. Here are the questions included on the PTGI-SF (Post Traumatic Growth Index – Short Form):1.I changed my priorities about what is important in life.2.I have a greater appreciation for the value of my own life.3.I am able to do better things with my life.4.I have a better understanding of spiritual matters.5.I have a greater sense of closeness with others.6.I established a new path for my life.7.I know better that I can handle difficulties.8.I have a stronger religious faith.9.I discovered that I’m stronger than I thought I was.10.I learned a great deal about how wonderful people are.(Cann et al, 2010)Ask yourself:Have you seen some PTG in yourself or another person after adifficult time?M5 Content Guide: The “Ordinary Magic” of ResilienceWhen learning about trauma or working with children and families who have had adverse experiences, it is easy to become overwhelmed by negative anddiscouraging facts about the effects of trauma. But the good news is that all children and families have strengths within themselves and their environments that they can call upon to build resilience. This module focuseson the science of resilience and on the strategies that parents, professionals,and communities can use to help children become stronger and better able to “bounce back” after difficulties.Resilience is defined as an “adaptive response in the face of significant adversity” (National Scientific Council on the Developing Child, p. 1). Decades ago, researchers began to wonder why some people seemed able to overcome great obstacles and lead healthy and successful lives while others seemed to have lifelong struggles and poorer outcomes. It was believed that there must be some “magic quality” innate in the resilient individuals that enabled their success. Over time, however, the study of

resilience has advanced and is now understood, not simply as discrete characteristics that a person either has or does not have, but as a complex interplay of individual and environmental factors. In 2001, researcher Ann Masten wrote, “Resilience does not come from rare and special qualities, but from the everyday magic of ordinary, normative human resources in the minds, brains, and bodies of children, in their families and relationships, and in their communities” (p. 235). Furthermore, it has been shown that people—even children—can learn to become more resilient (Administration for Children & Families, n.d.).Building Resilience in All ChildrenThe COVID-19 pandemic has reminded us that no child or family is immune from struggle. Children and teens have had to cope with a range of hardships and adjustments, such as the deaths of loved ones, the transition to online learning, and changes in how family members and friends interacted socially. It is clear that children with a greater number of risk factors (e.g., living in poverty, predisposition for mental health problems) were likely to face more and harder challenges during the pandemic. However, the global threat of COVID-19 and its associated changes in how we live offered opportunities for growth and the development of resilience. For example, new schedules have afforded some families the opportunity to connect more and in new ways and less time in structured activities gave children and teens a chance to develop new skills and hobbies at home (Dvorsky, Breaux & Becker, 2020).Remember the concepts of positive and tolerable stress from Module 2? The video, a TED Talk by psychologist Kelly McGonnigal (2013, 14 minutes in length, captioned) explains more about how the stress of facing challenging events and circumstances can help us (children, teens, and adults) become more resilient. Research has found that the experience of coping with stress can make the brain more able to adapt to future challenges and may even change the way genes express themselves, leading to greater adaptation and resilience (National Scientific Council on the Developing Child, 2015). Formany children, the pandemic and its related positive and tolerable stressors presented an opportunity to become stronger and weather future storms in their lives.Ginsburg’s 7 Cs: The Essential Building Blocks of Resilience

Pediatrician and professor Kenneth Ginsburg studies has developed guidancehe calls, “7 C’s of Resilience,” to help parents and professionals promote resilience in children and teens. Throughout this module, think about how you might incorporate these ideas into your interactions with young people, as a parent, mentor, or professional helper. Feel free to view Dr. Ginsburg’s strategies and philosophy.Bottom Line #1: Young people live up or down to expectations we set for them. They need adults who believe in them unconditionally and hold them to the high expectations of being compassionate, generous, and creative. Competence: When we notice what young people are doing right and give them opportunities to develop important skills, they feel competent. We undermine competence when we don't allow young people to recover themselves after a fall.Confidence: Young people need the confidence to be able to navigate the world, think outside the box, and recover from challenges.Connection: Connections with other people, schools, and communities offeryoung people the security that allows them to stand on their own and develop creative solutions.Character: Young people need a clear sense of right and wrong and a commitment to integrity.Contribution: Young people who contribute to the well‐being of others will receive gratitude rather than condemnation. They will learn that contributing feels good, and may therefore more easily turn to others, and do so without shame.Coping: Young people who possess a variety of healthy coping strategies will be less likely to turn to dangerous quick fixes when stressed.Control: Young people who understand privileges and respect are earned through demonstrated responsibility will learn to make wise choices and feel a sense of control.Bottom Line #2: What we do to model healthy resilience strategies for our children is more important than anything we say about them.[The 7 Cs are an adaptation from The Positive Youth Development movement. Rick Little and colleagues at The International Youth Foundation first described the 4 Cs of confidence, competence, connection, and character as the key ingredients needed to ensure a healthy developmental path. They later added contribution because youth with these essential 4

characteristics also contributed to society. The additional two C’s – coping and control – allow the model to both promote healthy development and prevent risk.]M6 Content Guide 1: How Parents Can HelpIntroduction to Part I: How Parents Can Help Their Children With TraumaIn Part I of this module, we will take up what parents can do to help or hindertheir child's healing from trauma. We will look at what the empirical research, scant as it is, tells us about how a parent's response to the child affects the child's outcomes.We'll see how a parent can hinder a child's recovery by avoiding the reality of the traumatic event and the child's expectable reactions to it; by having their own trauma reactions get in the way; by ineffective parenting practices;and by shaming or blaming the child for the event or for their reactions to the event.Finally, we will look at how parents contribute to the healing of a child who has experienced trauma:By providing safety: From external realities and from internal triggersBy building connection: Addressing attachment rupturesBy building coping skills (executive function, problem-solving skills, mastery)By assisting the child in self-regulation of hyper-arousalA. What the empirical research tells us about how parents can help or hinder their child’s healingStrong empirical evidence shows that parents can hinder the child’s recovery in the following ways:1.When they avoid addressing the traumatic event or their child’s reactions toit (Ostrowski et al, 2011)2.When their own trauma reactions get in the way (AACAP, 1998; Ostrowski et al, 2011; Scheeringa & Zeanah, 2001)3.When they use ineffective parenting strategies (Scheeringa & Zeanah, 2001)

4.When they blame/shame the child (Cohen & Mannarino, 2000; Yasinski et al, 2016)Let’s take up each of these parent hindrances in turn:1. AvoidanceParent avoidance of addressing the traumatic event, or the child’s reactions to it, leads to worse outcomes for the child.Think about why parent avoidance leads to worse outcomes. Think about why do parents avoid addressing the trauma.Antidote: Acknowledging that an exposure to trauma has occurred and that the child is likely to have reactions to it.2. The parent’s own traumaThe parent’s own post traumatic stress or PTSD can lead to worse outcomes for the child.Think about how is it that acute parent distress can lead to worse outcomes of the child.Think about if there are times when parent PTSD could contribute to good outcomes for the child.3. Styles of ineffective parentingThree ineffective styles of parenting in the aftermath of child trauma were identified by Scheeringa & Zeanah (2001): Withdrawal and unavailability; over-protectiveness; and frightening over-involvement.Think about how these strategies might affect the child.Think about whether you can appreciate the pull of any of these parent strategies?4. Blaming the child for the trauma or for their reactionsWhen the parent blames the child for the trauma exposure or shames the child for their reactions to the trauma, the child will have worse outcomes.Think about how blaming and shaming a child can harm the child’s recovery.Think about what might lead the parent to blame the child.What does the empirical research say about parents can help?Oddly there is little research on how specifically parents can help in the recovery of their children from PTSD (Alisic et al, 2012; Appleyard & Osofsky,2003; Gewirtz et al, 2008). There have been many calls for empirical research on the question, but few researchers have taken up the task.Cohen (2009) identified six major parental tasks by reviewing the literature:

1.Safely structuring the environment [SAFETY]2.Helping the child regulate emotions [SELF-REGULATION]3.Modeling coping [TEACHING PROBLEM-SOLVING]4.Providing availability [LISTENING]5.Addressing child’s confusion and fears [LISTENING]6.Processing the event as a meaningful narrativeLet’s take up #1 and #3 of these parent supports in turn.1. Safely structuring the environment.Make the environment safe from new threats and from reminders (triggers) of past threats.Definition of “safe-enough environment”: It is one in which 1) caregivers are able to protect their child from actual threats, and 2) caregivers are able to protect their child from stimuli that provoke dangerous survival states and 3) help their child regulate dangerous survival states (Saxe et al., 2016).The Importance of safety for the child:So that child is not re-traumatized or constantly triggered to re-experience past trauma;So that child can regain a sense of control over the environment and his/her own reactions to it;So child can begin to heal.What parents can do to provide safety:Clear real threats: Identify the real threats and make at least the minimum changes needed to provide the child with safety.Clear triggers: Identify the triggers and help the child understand her responses to triggers and clarify with the child what help is needed at each point in the cycle.Develop a plan with the child to keep him safe: including gradual in vivo exposure; developing new skillsOffer safety signals proactively, e.g., sending safety signals versus threat signals (Saxe et al., 2016).Clear real threats from the environment:This might seem simple, but in many cases, it’s not! Why is this sometimes very hard for parents to do, do you think?In some situations, you will assess that the risk to the child is too great, and you must take immediate action to protect the child. If so, tell the parent

and call in a mandated CPS report advocating for immediate investigation and removal.oAssess how close the family is to achieving a safe-enough standard? Can they get there in a timely way?oWhen is this piece of the work done? When the child can safely move through life without being constantly triggered.Clear the environment of triggers - Clearing the environment of triggers is also hard. Identifying what may trigger the child requires a close reading of the child’s subjective experience. It is a sophisticated skill to identify with thechild and imagine what their experience must be. Then it’s demanding to address it with the child. What to do:Identify triggers: Parent uses empathic attunement to child; parent uses parent reflective function; put self in child’s shoes; tune in to child’s subjective reactions which may surprise you and may change over time;Some triggers you can avoid at least temporarily as the child recovers. Sometriggers can’t be avoided, must be gradually accommodated to with lots of supports. Some triggers can be eliminated altogether if harmful and unnecessary.Develop a plan to establish and maintain safety:A safe environment doesn’t just happen on its own, or by wishful thinking! It takes a concerted plan: What the parent will do, what the child will do, whatthe treatment team and social supports will do.The plan will cover how each party will handle the emergencies of real threats and triggers.Even if trauma exposure is a “one-off” like a car accident, triggers can be toxic and should be proactively planned for as they become known.It’s not enough to establish safety at the beginning of treatment. It’s got to be maintained. For example, if a child’s after-school safety depended on a grandmother’s care and she gets ill or moves away, that environment is no longer safe.Offer safety signals - Parents can also regularly offer “safety signals”, experiences and reminders of being cared for, to enjoy:"You will be understood.”o“You will be helped. I am with you.”o“I won’t punish you for your reactions, and I will keep you safe.”Instead of signals of threat such as:o“You deserve what you get! You always get into trouble!”

o“You always take things too hard!”o“I don’t have time for you!”o“I don’t want to know what you’re feeling!”(Saxe et al., 2016)Modeling coping - Ginsburg (2020) also has an admired guidelines for parents about how to help a child build executive function and problem-solving, what he calls “giving kids roots and wings”:Competence: When we notice what young people are doing right and give them opportunities to develop important skills, they feel competent. We undermine competence when we don't allow young people to recover themselves after a fall.Confidence: Young people need the confidence to be able to navigate the world, think outside the box, and recover from challenges.Contribution: Young people who contribute to the well-being of others will receive gratitude rather than condemnation. They will learn that contributing feels good and may therefore more easily turn to others, and do so without shame.Coping: Young people who possess a variety of healthy coping strategies will be less likely to turn to dangerous quick fixes when stressed.Control: Young people who understand privileges and respect are earned through demonstrated responsibility will learn to make wise choices and feel a sense of control(Ginsburg & Jablow, 2020).Faber and Mazlish (1980) have an enormous following in parent training circles. This is what they advise parents to do to encourage their child’s autonomy:1.Let children make choices.2.Show respect for a child’s struggle.3.Don’t ask too many questions.4.Don’t rush to answer their questions [let them think it out as far as they can].5.Encourage children to use sources outside of the home.6.Don’t take away hope.(Faber & Mazlish, 1980)Lastly, one of the very few empirical studies of how parents can help was done by Alisic and her team (Alisic et al, 2012). She asked parents of children who had experienced an auto accident

on what they believed they did that most helped their child. This is a summary of what they said:1. Being aware of a child’s needsAsking a child how he/she feels about the eventComparing behavior before and after traumaAppraising reactions in light of a child’s character2. Acting on the child’s needsProviding opportunities to talkAnswering questions at the child’s paceHiding own distressUndertaking symbolic activitiesProviding fun activities and enjoyable moments(Alisic et al, 2012)M6 Content Guide 2: How Counselors Can HelpIntroduction to How Counselors can Help a Child Heal from a Traumatic ExposureWe will look at three widely used evidenced-based methods of child trauma treatment:Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)Child/Parent Psychotherapy (CPP)Trauma Systems Therapy (TST)For each method, we will look at their purpose and goals for the child’s best outcome from treatment; the "active ingredient" believed to make the treatment method effective; and the key interventions in the method.We will look at how each method provides safety, connection and self-regulation, the “three pillars” of trauma treatment, the core elements of all trauma treatment models according to a review conducted by Bath (2008).Students will then build their own mix of intervention strategies using elements from TF-CBT, CPP and/or TST for a case.II. How counselors can help a child heal from a traumatic exposureA. The universe of evidence-based models of child trauma treatment

NCTSN hosts 37 EB (or evidence-informed) models of child trauma treatmentwhich have joined their network. Most have just one study to prove their efficacy, but others have multiple studies, TF-CBT, for example, proving efficacy with different populations of children, such as children who have survived sexual or physical abuse, accident survivors, or were trafficked children.Here is how the developers can prove the efficacy of their treatment model. (That is, what constitutes the “evidence base” of a model.)How evidence-based studies are conducted: Take two groups of randomly assigned clients, and give one group your treatment, and the other group “treatment as usual” for that setting. Give before and after tests to both groups using valid measures of the outcome variables you’ve chosen (depression, anxiety, school performance, etc.). At the end of the treatments, measure if your treatment group fared better – to an extent that is statistically significant – than the ”treatment as usual” group.Now we will look at three of the most widely used EB methods of child trauma treatment: Child/Parent Psychotherapy, Trauma-Focused Cognitive Behavioral Therapy and Trauma Systems TherapyWe will compare three key elements of the three programs:1.We will look at the purpose and desired outcome of each treatment2.The mechanism of change, or “active ingredient”, of each treatment3.The method or interventions of each treatmentWhat is the mechanism of change?This is the formal term for “the active ingredient” or what is curative about the method according to its developers.A brief aside: It’s important to know that the mechanism of change is not proven by an efficacy study – only that the treatment as a whole has efficacy.Only one brave developer team has done a “dissembling” study, and that is TF-CBT. They found that their much touted “mechanism of change” was not what actually helped make their treatment so effective! A surprise to everyone!!

How does this make sense? Multiple studies comparing the efficacy across different models has shown that it is the treatment relationship rather than the specific method that makes for a successful treatment. This is why beginning counselors often have as much success with clients as master therapists do. Remember that, and be reassured, all of you beginning counselors!Another key finding was made by Bath who found that all trauma models hadthree elements in common: promoting safety, connection, and self-regulation(Bath, 2008).B. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)PURPOSE OF TREATMENT:The purpose of treatment is to lessen the intensity of the child’s painful thoughts and feelings associated with her/his memories of the trauma events. It is also to lessen how disruptive these painful thoughts and feelings are to the child’s well-being and ability to function. This is meant toreturn a sense of inner control to the child. And it is to break the automatic association between the memory of the trauma and the painful reaction to the memory.The second purpose of the treatment is to develop the parent or caregiver asa skilled “therapeutic resource” for the child after the treatment ends so that the trauma can continue to be discussed as needed in ways that are helpful to the child.WHAT IS BELIEVED TO BE CURATIVE (MECHANISM OF CHANGE):The first curative factor is that the child learns to lessen the painful feelings that arise in relation to the trauma by practicing a range of CBT skills: challenging the inaccurate and unhelpful thoughts that fuel painful feelings;identifying and rating the intensity (1-10) of the painful feelings; relaxing the body in the face of intense affects; stopping disruptive thoughts.The second curative factor is the gradual desensitization of the child to the trauma memories. This occurs during the construction of the “Trauma Narrative”.METHOD: TF-CBT relies on two major interventions:1.The therapist teaches cognitive processing and emotional regulation skills to the child and to the parent which work directly to minimize the child’s painful affects and control the intrusion of disruptive thoughts;

2.The therapist guides the child through a process of desensitization to the facts and memories of the traumatic events by creating the “Trauma Narrative” and sharing it with the parent(Cohen et al, 2006).Let’s identify the roles of parent, child, counselor in this treatment method.C. Child/Parent Psychotherapy (CPP)PURPOSE OF TREATMENT:The primary purpose is CPP is to heal the rupture in the child-parent relationship that the trauma may have caused and to build “a growth-promoting child-parent relationship can then support the ongoing healthy development of the child…” (Lieberman et al., 2015, p. 31).WHAT IS BELIEVED TO BE CURATIVE (MECHANISM OF CHANGE):What is curative about the CPP method is that with the right responses from his or her parent(s), the young child no longer feels alone and overwhelmedby the devastating experience of trauma. The child feels accepted, supported, loved, and protected from danger and fear by the people most meaningful to her, her parents. In healing interactions with the parent, the child sees that she can begin to feel differently, feeling “pleasure, mastery and hope” in Lieberman’s words And she may also learn less harmful ways of expressing her powerful reactions to the trauma.THE PARENT’S ROLE IN THE CURE:Because the parent is the child’s protector and provider – the guardian of thechild’s well-being in attachment terms – it is critical that the parent, not justthe therapist, grasp the impact and meaning to the child of the trauma experience. “The parent is indispensable for the child’s recovery, because the child’s primary concern is to keep the love and approval of the parent” (Lieberman et al., 2015, p. 78).In every session, CPP puts the parent in the position to hear and acknowledge the child’s experience, to reassure the child that he/she is not to blame, that the parent is not mad; that the parent loves her/him, and that the parent wants to provide protection and care.Initially, the therapist models and leads the parent in identifying the child’s trauma story, trauma reactions, and wishes in the context of the child’s play. Once the parent understands and endorses the therapist’s interpretation of the child’s expression, it is the parent who acknowledges to the child what she is understanding and lends her support. Eventually

both the parent and the therapist discover and articulate these phenomena to the child in play.METHOD:CPP relies on three major interventions:1.Guiding the parent in understanding the child developmentally and what trauma reactions look like at the child’s age;2.Guiding the parent to identify and respond fruitfully to the young child’s experience of trauma expressed in play;3.Modelling for the parent what fruitful responses to the child can be.(Lieberman et al, 2015)D. Trauma Systems Therapy (TST)PURPOSE OF TREATMENT:The first goal of treatment is to develop the child’s ability to regulate “survival-in-the-moment” states, defined as “an individual’s experience of the present environment as threatening to his or her survival, with corresponding thoughts, emotions, behaviors, and neurochemical and neurophysiological responses” (Saxe et al., 2016, p. 33). These moments offlashbacks can trigger behavior that is harmful to self or others.The second goal is to develop the level of support and protection for the child from all the adults in the environment so that further trauma can be prevented and “survival-in-the-moment” flashbacks can be managed. WHAT IS BELIEVED TO BE CURATIVE (MECHANISM OF CHANGE):The first curative factor is ridding the environment of actual threats and as many reminders of the original trauma as possible.Secondly, when the child and caregivers learn what triggers the child’s survival state cycle – and exactly how the survival-in-the-moment states work for the particular child – they can intervene at each point in the cycle to offer what the child needs to return to normal regulation.METHOD:The TST method begins by organizing a treatment team for the specific child:identifying decision-makers in each service system affecting that child’s wellbeing; enlisting their participation; creating a joint treatment plan with them; and sustaining ongoing contact, (service integration). Family members may play a minor part on the team. They are seen as recipients ofthe treatment plan but tasked with implementing key goals of treatment.

The team will work with the parent to structure safety throughout the child’s environment.The TST therapist meets individually with the child to identify trauma triggersand identify the child’s unique physiological and emotional signs of stages of survival activation (re-experiencing). Then the TST therapist meets with caregivers to “attune them” to the child’s triggers and needs when they getactivated(Saxe et al., 2016).M7 Content Guide 1: "Inherited", Historical, and Generational Traumas"Inherited" TraumasSome trauma reactions occur, not because of events that an individual has experienced, but in response to major traumas that happened to that individual's ancestors. Research on this idea is relatively new, having emerged only in the last three or four decades. This module's readings and videos will describe some theories that seek to explain how trauma can be "passed on" from one generation to the next within families and communities. Here we will define some important terms and explain foundational concepts.Historical TraumaNative American clinician and researcher Maria Yellow Horse Brave Heart (2003) defines historical trauma as the "cumulative emotional and psychological wounding over the lifespan and across generations, emanatingfrom massive group trauma experience.” This wounding is the result of majoroppressive events in history such as slavery, genocides, forced migration or institutionalization, or violent colonization. One of the most well-known examples of historical trauma is the experience of Native Americans. Due to colonization, violent removal from their land, and mass extermination, NativeAmerican communities suffered a loss of cultural practices and traditions, which has impacted many generations. As a result, many people in indigenous communities suffer trauma effects such as poor overall health, substance abuse, and mental health problems (SAMHSA, n.d.)Historical trauma may be expressed as unresolved grief when the group's historical oppression has not been fully or sufficiently recognized by the larger society. The ancestors of groups that experienced major traumas may

be unable to voice their rage and grief openly and, for some, these feelings become internalized, leading to a sense of self-hatred (SAMHSA, n.d.).Daily experiences of racism and discrimination can compound the problem ofhistorical trauma, as individuals are reminded of their cultural group's "second class" treatment and may only have access to resources through thetypes of systems that oppressed their ancestors. Mistrust of government, majority groups, and service providers is not uncommon (Administration for Children & Families, n.d.).Some scholars, however, warn that the concept of historical trauma can serve to further pathologize and stigmatize certain cultural groups and shifts focus away from traditional healing practices and the ways in which resilience is passed across generations (Denham, 2008; Maxwell, 2014). When working with any individual or family, and particularly those with traumatic cultural histories, helpers should not apply labels or make assumptions and should seek to emphasize cultural., family, and individual strengths.Generational TraumaGenerational (sometimes called intergenerational) trauma may be related to oppressive historical events like those discussed above. However, this concept also includes traumatic events experienced by individuals or families, the effects of which are then felt by generations that follow. Research into generational trauma began with the children of Holocaust survivors, some of whom were found to have high rates of PTSD symptoms despite not having experienced the Holocaust themselves (Yehuda, et al., 1998). Later studies found that among war veterans who suffer from PTSD, their children are more likely to experience behavioral and mental health problems (see Dekel & Goldblatt, 2008, for review) and that the traumatic distress of refugee mothers can negatively affect family relationships and their children's mental health (Sangalang, Jager & Harachi, 2017). More personal traumas, such as violence, separation, or substance abuse within a family, may also have ripple effects on the generations that follow those whoexperience trauma; these can be included in the category of generational trauma. Another example of generational trauma is seen in the PTSD symptoms and academic and behavioral problems experienced by the children of war veterans (Dekel & Goldblatt, 2008).

There are several ways through which trauma is thought to be "transmitted" from one generation to the next. One theory is that the attachment bond between the parent and child is disrupted when the parent's trauma symptoms make it difficult for him or her to respond adequately to the child'sneeds (Isobel, et al., 2019). Another theory is that parents project, or unconsciously transfer, their strong feelings of aggression, shame, and guilt onto their children, who then incorporate those feelings into their sense of self (Srour & Srour, 2006). More recent research suggests that the transmission of trauma from one generation to the next happens not only through psychological or behavioral mechanisms, but through genetic variations that are the result of trauma (Ryan, et al., 2016). This epigenetic theory is still in an early stage and has not yet been thoroughly validated.M7 Content Guide 2: Racial TraumaRacial TraumaAlso called race-based stress, racial trauma refers to the effects of real or perceived racial discrimination among Black people, indigenous people, and people of color (BIPOC). Threatening events that may lead to racial trauma include harm or threats of harm, humiliation, microaggressions, and witnessing the racial discrimination of others (Comas-Díaz, 2016; Comas-Días, Hall & Neville, 2019).Racial trauma may result from present-day traumatic events that are experienced by an individual (such as hate crimes or discrimination at work or school) or events that a BIPOC witnesses either in person or through media. The killing of unarmed black men by white police officers is an example of a traumatic event for many members of the Black community.Repeated and ongoing race-related threatening experiences can have a cumulative effect on BIPOC (Comas-Diaz, 2016; Hart, 2019). These everyday harmful experiences of discrimination may be compounded by the shadow ofhistorical trauma that oppressed cultural groups and communities have experienced over generations, as discussed in Content Guide 1. America's history of slavery, Jim Crow, and the targeted violence against African Americans is an example of historic trauma, as are the forced migration and genocide against Native Americans, and the genocide of Jewish people by the Nazis in Europe in the 1940’s (Degruy, 2017; Menakem, 2017).

Treatment of Racial TraumaThe mental health field has ignored the impact of racial trauma on BIPOC until recent decades and there is now a call for clinicians to address race-related stressors and traumas as well as race-related positive experiences (Bryant-Davis & Ocampo, 2006.) Assessment and treatment should, of course, avoid stigmatizing and labeling BIPOC individuals who seek treatment or placing people in the role of "victim" because of their race or cultural background; however, ignoring issues of race and racism's harmful effects only further marginalizes and isolates people who have suffered its effects.The following model of healing from racial trauma and stress (Bryant-Davis &Ocampo, 2006) was developed for use with adults. However, as you read, please consider how these strategies might be applied to children and families of color.1.Acknowledge the racist incident.2.Share the trauma in a safe environment.3.Enhance safety and self-care.4.Grieve and mourn the losses (disillusionment, history of ancestors, etc.)5.Examine shame, self-blame, and internalized racism.6.Demand equalityTherapist and author Resmaa Menakem, in his 2017 book My Grandmother’s Hands: Racialized Trauma and the Pathways to Mending our Hearts and Bodies, suggests that all people--regardless of race--hold the trauma of livingin a racist society in the body and proposes a model of healing through body work. His strategies include first, becoming aware of how the body reacts to racialized situations; for example, does the fight, flight, or freeze response emerge in the body in some way? Menakem's book also guides readers through exercises that include things like rocking, humming, visualizations, and physical touch as means through which racialized healing can take place.You will learn more about Menakem's ideas and practices when you listen to the podcast listed with the required reading for this module.Racial Trauma and ChildrenParents and other helping adults may avoid discussions of race and racism with children, for fear that they will say the wrong thing or expose children toconcepts that they cannot yet understand. However, it is important that we

not underestimate what children already know, experience, and feel about race, regardless of their own racial background.The research organization Child Trends offers some practical advice about how to speak with children about race and how to support children who are experiencing racial stress and traumaM8 Content Guide – Burnout and Self-care for helpersBurnout and Self Care for Helpers of ChildrenWorking with children and teens who have experienced trauma can be emotionally and physically taxing for helpers and counselors. It is difficult to witness children and families who are suffering day after day. Helpers who do neglect their own personal needs may begin to experience burnout. Burnout is, "a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity" (Mayo Clinic,n.d.).Some symptoms of burnout include:becoming cynical about the work you dobeing critical of clients and coworkersimpatience and irritabilitydifficulty concentratinglack of satisfaction with workdifficulty letting go of work problems when you get homelack of energytrouble sleeping or sleeping excessivelyusing alcohol, drugs, or food to cope with negative feelingsunexplained physical symptoms such as headaches or stomach achesTo prevent burnout, it is crucial to engage in self-care. Self-care is the ability to attend to one's own needs so as to promote physical and emotional well-being.This module's required reading, an article entitled "Dear mental health practitioners, take care of yourselves: A literature review on self-care." (you may need to click "Get Full-Text" button on right side) by Posluns & Gall (2020) which will give you a better understanding of the importance of self-care and some strategies to increase self-care in your own life.